The Troubled Winter

Winter is coming! Is it just the ominous motto of House Stark in the famous HBO show Game of Thrones? I think it should be our warning motto in Pediatric Emergency Medicine.

It is the season of long wait times, the influx of unprecedented numbers of patients, the wonderful bronchiolitis, the respiratory viruses that would bring every patient possible with asthma exacerbation, the holidays that bring with it the upset stomach and gastroenteritis.

Many emergency rooms around the country are staffed and supplied according to costs rather than needs. This will lead to understaffing and and create terrible conditions for patients and healthcare workers. The puzzling part is that no one can predict what can walk through the ER door. We All think that we can handle it, we push patients in, place them in chairs and stretchers across the hallways, then the reality hits us! Patients are not triaged or registered, vital signs are not recorded and nurses are not available to evaluate or give medications. This constant stress for patients and staff comes with Winter. Is it poor planning? Is it the lack of enough staffing? Is it the roadblocks that the system created? We are forced to change our practice and alter our standard of care by discharging patients without being properly triaged or not giving medications and relying on prescriptions that patients may not even fill. These practices may put us at a higher risk of committing an error and lower patient’s satisfaction. But what worries me the most is discharging a patient who should have been evaluated further, because we are crossing these checks that may prevent us from committing such mistakes.

How can we solve this chronic problem? Is it the institutional policies? Is it the chronic lack of staffing? Is it just a financial issue? Or is it just bad planning? A quick PubMed search showed a very limited amount of information available in this field. One study from Australia concluded that some conditions (Croup, Bronchiolitis, diarrheal diseases) do have seasonal variations. Another suggested providing staffing and space during these months did improve the throughput at their Pediatric Emergency Department.

I hope one day similar plans are implemented across the country to improve the overall patient conditions and reduce healthcare workers strain. Can we see that coming? Not sure if that will happen soon enough.

What do you think about this topic? Please share your thoughts or institutional experience in tackling this issue.